Depression during the perimenopause: A meta-analysis

During the perimenopause:•The odds on depressive symptoms are increased when compared to the premenopause.•Women report a higher level of depressive symptom severity when compared to the premenopause.•There are indications that vasomotor symptoms are positively related to depressive symptoms during the perimenopause.

BackgroundWomen are believed to be more vulnerable to develop a depression or depressive symptoms during the perimenopause. Estimates from individual studies are heterogeneous and hence true risk estimate is unknown.ObjectiveThis study investigated the risk on clinical depression and depressive symptoms during the perimenopause when compared to other female hormonal stages.MethodsWe performed a meta-analysis of 11 studies identified in Pubmed, Web of Science and the Cochrane library (up to July 2015). Studies were included when the perimenopause was defined according the criteria of Stages of Reproductive Aging Workshop (STRAW). The outcome measures were Odds Ratio's (OR) on depression diagnosis and depressive symptoms and standardized mean difference (Hedges's g) in depression scores during each menopausal stage.ResultsThe odds to develop a depression were not significantly higher during the perimenopause than in the premenopause (OR=1.78 95% CI=0.99-3.2; p=0.054). A higher risk was found on depressive symptoms during the perimenopause as compared to the premenopause (OR=2.0, 95% CI=1.48-2.71; p<0.001) but not compared to the postmenopause (OR=1.07, 95% CI=0.737-1.571; p=0.70). There was a higher symptom severity of depression in the perimenopause when compared to the premenopause (Hedges's g=0.44, 95% CI=0.11-0.73, p=0.007). The odds on vasomotor symptoms and depression were 2.25 (95% CI=1.14-3.35; p<0.001) during the perimenopause.LimitationsTime interval in measuring the depressive symptoms was different in studies. Menopausal symptoms possibly may have confounded our results by increasing the scores on depression questionnaires. Publication bias needs to be considered.ConclusionThe perimenopause is a phase in which women are particular vulnerable to develop depressive symptoms and have higher symptom severity compared to the premenopause. There are indications that vasomotor symptoms are positively related to depressive symptoms during menopausal transition.